Provider Demographics
NPI:1386700987
Name:BATTISTA, CARL JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:JOHN
Last Name:BATTISTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 KINDERKAMACK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-1500
Mailing Address - Country:US
Mailing Address - Phone:201-634-1004
Mailing Address - Fax:201-634-1028
Practice Address - Street 1:550 KINDERKAMACK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-1500
Practice Address - Country:US
Practice Address - Phone:201-634-1004
Practice Address - Fax:201-634-1028
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA52417208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics